It's probably an understatement to say that these are unusual times. Many of us alive today have not experienced a true pandemic or a world war, the only things that compare to what we are dealing with now. We've never been asked to shelter-in-place or close our businesses for an extended time unless we've been personally affected by a major natural disaster. We've never had a situation where it was imperative that we put the common good above our own wants and needs to save lives.
As a patient with a chronic illness, I've felt anxiety in the past. After 15 years with Ankylosing Spondylitis (AS), I've had a quite a few "scares." And each time I had a scary challenge, I worked my way through it with my medical team. But again, these times are different, and I haven't heard a peep from my medical team. Frankly, I think they were just unprepared for how they would support large numbers of patients in a scenario like this.
I don't share this because I want sympathy or even because I want people to understand why it's important to help protect those at risk by practicing social distancing, although I feel that is critically important. I am sharing this because I have seen a radically wide gap in the communication being sent to high risk patients, and I think it increases stress and fear.
I have a specialist, a primary care doctor, and, until quite recently, received monthly infusions at my local hospital. Not one of these groups has contacted me with any guidance or resources. I have been left entirely to my own devices. Luckily, I work in healthcare IT as a provider of education to the healthcare industry so I am on a hundred mailing lists and am receiving more updates on COVID-19 than I could ever need. But, what about all the millions of high risk patients who don't work in healthcare?
I've had one friend with AS who did receive a communication from her rheumatologist. I mentioned it to another friend who said she'd also gotten nothing. The only provider who has sent me anything is my eye doctor who sent a mass email to all patients with updates on hours and services. Don't get me wrong, I think that was great, but it doesn’t help me understand my level of risk as a patient on two immune suppressing drugs.
For many patients with complex chronic conditions, stress, anxiety, and lack of sleep can increase symptoms and even cause other corollary illnesses to crop up. Information is a key tool in reducing that stress and anxiety. Healthcare organizations that aren't making an effort to communicate with their high-risk patients, might be making things worse for those patients.
Here are my recommendations for how to support high-risk patients in the coming weeks:
- As you look at cancelling non-essential appointments, reach out to patients with chronic conditions differently. Many wait on necessary things until their scheduled visits every three or six months. They may be having new symptoms, pain, or other issues. In other words, they may be scheduled for a routine appointment but have critical needs. Email, text, or call to discuss the best approach for their upcoming appointments.
- For patients who do still need a visit, offer telemedicine as an option. As most have already heard, CMS and the OCR are easing restrictions on telemedicine use. It is ideal for this purpose. Chronically ill patients can get the care they need without the risk of an in-office visit. Check with other payers on telemedicine coverage. If the payer won't cover the visit, verify with the patient if they want to schedule and self-pay.
- Communicate with high-risk patients regularly about COVID-19 to provide updates and recommendations. Depending on the communication tools you have at your disposal you may be able to identify specific risk groups based on different factors. If you are a specialist serving largely high-risk patients you may want to communicate with all patients weekly or bi-weekly. There are resources and information from the CDC on high-risk patients you can leverage for these communications or look to your specialty medical association for additional guidance.
- Get personal. It's great to send information to patients that is scientific and fact based about how to mitigate their risk and manage their health in the coming weeks and months, but as I mentioned before stress and anxiety can affect that health. Consider more personal check-ins with these patients, especially those who are truly isolated with little support. One way to identify more at risk patients is through a survey. Consider asking if they live alone, have family support, have a way to get their medications, access to a grocery service, etc. This can help your office identify patients who may need to be checked on.
- Check in on those high risk patients with a simple email, text, or call to make sure they are doing ok. Provide those patients with additional information about community support services being offered to help the most at risk.
It may seem like a lot of work to make an extra effort for these patients, but they are at a much higher risk for additional health issues as well as being at higher risk for COVID-19 complications. This extra effort can help reduce their anxiety, improve their quality of life, and even save their life.